Treating body dysmorphia

Body dysmorphia or body dysmorphic disorder (BDD) is a mental illness in which the sufferer obsesses over their body image. This might be a particular body part, a facial feature or weight/proportions.


Lots of us have the odd insecurity in relation to body image and this is normal, however, BDD is very different to this. The sufferer will fixate on a perceived flaw or defect and it ultimately leaves them feeling overwhelmed, confused, exhausted, scared, distressed and often leaves little room to think about anything else. It has a huge impact on their life, relationships and happiness.

What symptoms does body dysmorphia include and what causes it?

BDD often includes body checking, rituals and other OCD type behaviours in an attempt to cope with the negative thoughts and feelings around the particular feature. These coping mechanisms actually increase anxiety and obsession because they are not tackling the underlying causes of BDD. BDD is caused by trauma (in particular childhood teasing and bullying), low self-esteem, depression/anxiety, or perfectionism. 

Is body dysmorphia down to genetics?

Some research suggests that genetics play a part in BDD, however the most likely answer is that we grow up modelling and mirroring the behaviour of those around us. We pick up on behaviour (both consciously and unconsciously) that we internalise and then carry with us into adulthood.

An example of this might be a young child watching their parent try on clothes for an evening out and comment on "needing to go on a diet". Although the message is not directed at the child, the child instinctively trusts and listens to the parent, and therefore internalises the indirect message that there is a certain look/weight that is acceptable, and another that is not.

How do you know if you are struggling with body dysmorphia?

Perhaps you find yourself avoiding mirrors/photographs of yourself, or you might obsessively look in mirrors. You might try to hide certain parts of your body or feel dread that someone might make a comment about it. You may feel yourself withdrawing from social situations in an attempt to avoid feelings of insecurity.

Often you will feel distracted from work or engaging in relationships with others because you will be preoccupied with BDD thoughts. It may cause you to use destructive behaviours, self-harm or self-sabotage because the feelings of insecurity just feel too much.

How do you treat body dysmorphia?

Whatever you are struggling with, there is a way forward and BDD can be successfully treated through therapy. Therapy enables you to explore the core beliefs, trauma and underlying feelings behind the BDD. You will be able to challenge the negative thoughts around body image, build self-esteem and learn new coping mechanisms away from the disordered thoughts.

Dependent on how severe the BDD is, a mixture of one to one and group therapy might be helpful and in extremely severe cases, inpatient support may also be necessary. BDD presents differently for each person so it is important to find tailored, individualised and holistic care.

The views expressed in this article are those of the author. All articles published on Counselling Directory are reviewed by our editorial team.

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London W1U & SE13
Written by Beth Hawley, MBACP
London W1U & SE13

Beth is an integrative therapist working in Brighton, London and online via zoom. Beth specialises in working with clients suffering from eating disorders, body dysmorphic disorder, substance abuse and unprocessed trauma.

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